Debating the nature of attention deficit doesn't help people struggling with symptoms. But challenging other assumptions could.
by David Bernstein
A series of articles and books have popped up lately denying that ADHD is a legitimate disease. Some have cited allegations that Dr. Leon Eisenberg, an early pioneer in identifying ADHD, made a deathbed confession that ADHD is a “fictitious” disease.
So is ADHD a legitimate disease? The first question that needs to be answered is: What’s a disease?
Diseases are social constructs. Our concept of disease is linked to our understanding of what constitutes “normal” human health. Diseases are deviations from the norm that are believed to be damaging to the individual and, in some cases, society.
Genius, for example, is a deviation from the norm, but it’s viewed as an asset, not a liability. It is not a disease. We wouldn’t think to treat a high IQ.
Diabetes, on the other hand, is considered a disease because it’s a deviation from the norm and it’s viewed as harmful to the individual. Slapping on the disease label gives permission to the medical establishment to develop treatments that alleviate these symptoms and presumably improve the length and quality of life of those who have been diagnosed. If the vast majority of people had diabetes, it would be considered normal human health, and the lucky few who were able to produce insulin more efficiently would be considered exceptional, like geniuses.
Likewise, the condition we call schizophrenia is a deviation from the norm, and most of those who show symptoms — delusions and hallucinations — are viewed as a threat to themselves and society. Giving medication for schizophrenia narrows the gap between schizophrenic behaviors and the norm, and allows a person to live a more productive life.
It gets murkier with ADHD, which qualifies as a deviation from the norm. Most people don’t have ADHD behaviors, or it would be considered normal to leave your suitcase on the train or zone out when someone is talking to you. But unlike diabetes and schizophrenia, there’s some question about whether the treatments help the person with ADHD live a healthy and productive life in the long term. Indeed, the traits associated with ADHD often come packaged with high-value strengths. Being preoccupied with the perceived weaknesses of ADHD may hurt the individual’s self-esteem and, potentially, his contribution to society.
What’s more, labeling ADHD as a disease puts teachers, guidance counselors, doctors, and parents on autopilot; they believe that anyone who exhibits the symptoms has the disease and should receive treatment, notwithstanding the potential downside. “Child can’t pay attention in class, acts out? Get him on meds.” Because of the disease label, we become locked in and willing to overlook the medication’s negative side effects.
A better way of thinking about ADHD is to put aside the issue of disease and try to determine if the individual would benefit from treatment in the long haul. I have a teenage relative who was diagnosed with ADHD as a young child. By all accounts, he’s a mess when he’s not on medication. He cannot function in an organized social setting. He can’t stand himself when’s he’s off medication. His mental state, without medication, would be debilitating.
Another child I know functions in organized social settings, but he can’t pay attention in class. His grades suffer from his inability to focus. When treated with medication, however, he feels drained of personality, less creative, and edgy. He also develops tics. Taken off the medication, his grades may go down, but, in the long run, he may be better off.
In the first case, the child is helped more than hurt by taking medication. In the second instance, the child is hurt more than helped. You could say that the first child benefits from the disease label and the second child is harmed by it.
The question, then, should not be whether a person having ADHD traits has a disease, but whether the adult or child will be better off — not the next day in class, but in the long run — undergoing treatment that reduces the normalcy gap. Will that designation and the associated treatments make for a happier, healthier, more productive and creative life? That’s not an easy question to answer, but at least it’s the right question.
David Bernstein is a nonprofit executive who lives in Gaithersburg, Maryland. He has two sons, ages seven and 15.